All roads lead to Rome, but some are safer

M. Di Mauro*, A.M. Calafiore, R. Lorusso

*Corresponding author for this work

Research output: Contribution to journalEditorialAcademicpeer-review


Since the first in-human implantation, trans-catheter aortic valve replacement (TAVR) has shown an exciting development in both technical and technological terms, becoming the standard of care for many patients, even not only inoperable ones. Although trans-femoral (TF) access has the scepter of first-line route for TAVR, in some cases, this access is not feasible, so several alternative routes were introduced over time. The network meta-analysis by Hameed et al. has the great merit to provide a comprehensive picture. Hence, through either direct and indirect comparison, the authors confirmed as TF is the gold standard as access, followed by trans-carotid and trans-subclavian. Conversely, trans-thoracic (trans apical and trans-aortic) routes are the least safe and should be reserved only to sporadic cases.
Original languageEnglish
Pages (from-to)4320-4321
Number of pages2
JournalJournal of Cardiac Surgery
Issue number11
Early online date30 Aug 2021
Publication statusPublished - Nov 2021


  • alternative access
  • trans-aortic access
  • trans-catheter aortic valve replacement
  • trans-femoral

Cite this